You have a 30 year old, (132lb, 5’6″) female patient
You have a 30 year old, (132lb, 5’6″) female patient with complaints of difficulty breathing for three days. The patient is diaphoretic, flushed and responds to loud verbal stimuli. She appears fatigued, speaks very slowly with 1-2 word dyspnea, has accessory muscle use of the neck, shoulders and abdomen, noticeable retractions to the suprasternal and intercostal regions with increased work of breathing. Very faint wheezes and lung sounds are heard bilaterally. Upon further assessment, you discover that she is an asthmatic with poor medication compliance and has been sick with a cold for the last week, with the complaint of difficulty breathing over the last three days. As you continue your assessment the patient becomes more obtunded and lethargic. Vitals are:
BP:136/82 P:118 RR:24 SpO2:89% EtCO2:44
What is your course of action for this patient in order of priority?
Is there any other information you would like to know about this patient? Will that change your interventions based off of new information discovered? Consider the difference if this was a scene call vs interfacility transport.
What is the ideal body weight of this patient?
What medications would you consider administering to this patient?
Would you intubate this patient? Please explain your answer.
If so, what would your vent settings be? If not, is there a non-invasive procedure that you would you consider?
What are some potential complications if this patient is placed on mechanical ventilation?
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